1506. Comparing Clinical Outcomes of HIV-infected to HIV-uninfected Older Adults Hospitalized with Community-Acquired Pneumonia
Session: Poster Abstract Session: HIV and Co-infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Barakat ID Week VACS HIV-CAP poster 9-2013.pdf (827.4 kB)
  • Background:

    Although community–acquired pneumonia (CAP) is a leading cause of death in HIV-uninfected older adults, health outcomes among HIV-infected older adults are not well defined.

    Methods:

    Associations between HIV infection and three health outcomes (30-day mortality, hospital readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined using data from the Veterans Aging Cohort Study Virtual Cohort of male Veterans age ≥50 hospitalized for CAP from 10/1/2002 to 08/31/2010. The association between age and HIV status (using CD4 cell count, viral load, or use of antiretroviral therapy [ART]) and 30-day mortality was assessed with Cox regression. Hospital readmission within 30 days post-discharge was analyzed by logistic regression and LOS by linear regression. All models adjusted for race, smoking status, pulmonary co-morbidity, alcohol and substance abuse.

    Results:

    Among the cohort of 117,557 Veterans (80,635 HIV-uninfected and 36,922 HIV-infected matched Veterans), 1455 (866 HIV-infected and 589 HIV-uninfected) met our eligibility criteria.  Compared to HIV-infected Veterans hospitalized for CAP, HIV-uninfected were more likely to be age ≥ 65 years (p<0.001), of white race (p=0.015), and to have an alcohol-related diagnosis (p=0.002). In multivariable models of the 1455 veterans, age ≥65 years and CD4 count ≤200 cells/mm3 were associated with increased 30-day mortality, whereas viral load was not. HIV-infected Veterans with CD4 count ≤200 cells/mm3 were significantly more likely to be readmitted within 30 days of discharge and had significantly longer LOS (LOS 12.5 days) compared to HIV-infected Veterans with CD4 count >200 cells/mm3(9.8; p=0.002) and HIV-uninfected (9.7; p<0.001).

    Among HIV-infected Veterans, those who were not on ART had a higher 30-day mortality (HR 2.94, p<0.001) and a longer LOS (LOS 13.0 days vs. 9.5; p<0.001).

    Conclusion:

    Older HIV-infected Veterans hospitalized with CAP who have CD4 count <200 have higher risk of 30-day mortality, readmission within 30 days post-discharge, and longer hospitalization compared to HIV-uninfected Veterans independent of HIV viral load. Among the HIV-infected Veterans, the lack of ART was associated with increased 30-day mortality and hospital LOS.

    Lydia Barakat, MD1, Manisha Juthani-Mehta, MD2, Heather Allore, PhD3, Mark Trentalange, MD, MPH3, Janet P. Tate, MPH4, David Rimland, MD5, Kristina Crothers, MD6, Amy Justice, MD2,4 and Vincent Quagliarello, MD, FIDSA7, (1)Infectious Disease, AIDS Program, Yale University School of Medicine, New-Haven, CT, (2)Yale University School of Medicine, New Haven, CT, (3)Yale University Program On Aging, Yale School of Medicine, New Haven, CT, (4)VA Connecticut Healthcare System, West Haven, CT, (5)VA Medical Center, Decatur, GA, (6)University of Washington, Seattle, WA, (7)Internal Medicine, Infectious Diseases, Yale University School of Medicine, New Haven, CT

    Disclosures:

    L. Barakat, None

    M. Juthani-Mehta, None

    H. Allore, None

    M. Trentalange, None

    J. P. Tate, None

    D. Rimland, None

    K. Crothers, None

    A. Justice, None

    V. Quagliarello, None

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